China-FETP and its Good Practice

China-FETP and its Good Practice

Dr Guang Zeng M.D, MScChief Epidemiologist of China-CDC

Founder and Honorary Advisor of China-FETP

Dr Guang Zeng M.D, MScChief Epidemiologist of China-CDC

Founder and Honorary Advisor of China-FETP

Contains Contains

Developing of China-FETP

Stories of good epidemiological practice

Definition of Field Epidemiology

Developing of China-FETP

Stories of good epidemiological practice

Definition of Field Epidemiology

Developing of China-FETP Developing of China-FETP

Two different types of epidemiological investigationTwo different types of epidemiological investigation

The epidemiological investigation  for academic research For scientific findings; cultivation of the scientific

research ability; selecting topics proactively; adequate argument;

selecting investigated sites; analysis of the public health academics points.The epidemiological investigation  for disease prevention and control

receiving emergency missions; building up practical problem-solving ability; being medical detectives; investigating the unknown event; selecting topics passively; emergency response; rushing to the scene; solving the difficult public health issue quickly.

The epidemiological investigation  for academic research For scientific findings; cultivation of the scientific

research ability; selecting topics proactively; adequate argument;

selecting investigated sites; analysis of the public health academics points.The epidemiological investigation  for disease prevention and control

receiving emergency missions; building up practical problem-solving ability; being medical detectives; investigating the unknown event; selecting topics passively; emergency response; rushing to the scene; solving the difficult public health issue quickly.

Definition of field epidemiologyDefinition of field epidemiology

The problems is unexpected.A timely response may be determined.Public health epidemiologists must travel to the field to solve the problem.The extend of the investigation is likely to be limited because of the imperative for timely intervention.

Michael B Gregg

The problems is unexpected.A timely response may be determined.Public health epidemiologists must travel to the field to solve the problem.The extend of the investigation is likely to be limited because of the imperative for timely intervention.

Michael B Gregg

The definition of field epidemiologyThe definition of field epidemiology

Field epidemiology is the methodology for solving all kinds of public health problem at field by using epidemiological methods and other scientific methods.

----Guang Zeng

Field epidemiology is the methodology for solving all kinds of public health problem at field by using epidemiological methods and other scientific methods.

----Guang Zeng

Characteristics of Field EpidemiologyCharacteristics of Field EpidemiologyPhilosophical perspective: Not only get to know the world, but also transform the world.Methodological perspective: A combination of the epidemiology and other disciplines.Team perspective: It is the public health team, not only the epidemiological investigation group.Training perspective: Insist on learning by doing. It’s different from the single model of classroom teaching or the research model of graduate students.Output perspective: To achieve the purpose of disease control, and put forward countermeasures and suggestions.

It’s not for report and academic papers.

Philosophical perspective: Not only get to know the world, but also transform the world.Methodological perspective: A combination of the epidemiology and other disciplines.Team perspective: It is the public health team, not only the epidemiological investigation group.Training perspective: Insist on learning by doing. It’s different from the single model of classroom teaching or the research model of graduate students.Output perspective: To achieve the purpose of disease control, and put forward countermeasures and suggestions.

It’s not for report and academic papers.

Chinese Field Epidemiology Training Program (CFETP)

Chinese Field Epidemiology Training Program (CFETP)

Negotiate with WHO in April ,established in Oct 15, 2001

Learn from EIS model, 2 year training for each cohort

Response SARS since Dec,2012 in Guangdong and Beijing

Have the first resident adviser in 2004

NCD  as the second training direction since 2010

Environmental health as the third direction since 2013

Great contribution from WHO,UNICEF,US-CDC 

Negotiate with WHO in April ,established in Oct 15, 2001

Learn from EIS model, 2 year training for each cohort

Response SARS since Dec,2012 in Guangdong and Beijing

Have the first resident adviser in 2004

NCD  as the second training direction since 2010

Environmental health as the third direction since 2013

Great contribution from WHO,UNICEF,US-CDC 

2001 年 10 月，中国现场流行病学培训项目正式成立

CFETP Mission CFETP Mission

Training qualified epidemiologists for China CDC and local CDC

Special team to response important   public  health 

events

Leadership of FETP network in  China

Bridge for epi international cooperation

Training qualified epidemiologists for China CDC and local CDC

Special team to response important   public  health 

events

Leadership of FETP network in  China

Bridge for epi international cooperation

1 Conduct rapid investigation and response to public health events

2 Respond to natural disasters and prevent disease outbreak

3 Conduct surveillance data analysis and evaluation

4 To advocate for public health actions through communications with the community, the media and decision-makers

5 Cooperation and coordination with partners

6 Planning, implementation of an epidemiological study

7 Write reports as scientific paper for peer-reviewed journals, and present at a national or international scientific conference

8 Te be a mentor of field epidemiological training

Eight Competencies

Four spiritsFour spirits

Dedication:    Dedication to public health and                          serving China

Teamwork:    Developing teamwork and                        partnerships 

Exploration:  Interest in scientific exploration                        and problem-solving 

Commitment: Commitment to truth and integrity

Dedication:    Dedication to public health and                          serving China

Teamwork:    Developing teamwork and                        partnerships 

Exploration:  Interest in scientific exploration                        and problem-solving 

Commitment: Commitment to truth and integrity

黄埔军校 -Whampoa military school黄埔军校 -Whampoa military school

Learning By Doing 2 Months Course 22 Months Field Work

Learning By Doing 2 Months Course 22 Months Field Work

Additional fundamental skills

to field work

Additional fundamental skills

to field work

Field Work

CFETP

Enrollment

Orientation

Basic

Coursework

Case

Study

Field

Exercises

Training base:Training base:

For more opprrtunities ,Shorten distance to the fieldWithin one provincial/metropolitan CDC Training and response collaborationTrainee as core person to responseLocal support and double guidance

For more opprrtunities ,Shorten distance to the fieldWithin one provincial/metropolitan CDC Training and response collaborationTrainee as core person to responseLocal support and double guidance

21 Local Field training base including 6 new developed

21 Local Field training base including 6 new developed

New developed

Previous developed

Qualification for certificateQualification for certificate

2 full years training involment4 or more emergent response to public health events,at least 2 were in core part.

2 or more surveillance evaluation,all were done by himself

1 or more planned project by himself 2 topic report report and defence face CFETP committee,1 of the 2 is emergent response

2 full years training involment4 or more emergent response to public health events,at least 2 were in core part.

2 or more surveillance evaluation,all were done by himself

1 or more planned project by himself 2 topic report report and defence face CFETP committee,1 of the 2 is emergent response

Always the pioneer to rsponse emerging eventsAlways the pioneer to rsponse emerging events

Group efforts  Trainee,  Monter,  Resident adviser  Other department of China-CDC  Local CDC  Clinical doctors  Other contributors    

Group efforts  Trainee,  Monter,  Resident adviser  Other department of China-CDC  Local CDC  Clinical doctors  Other contributors    

FETP pyramid in China FETP pyramid in China

CFETP

 Provincial FETP

City FETP

Non FETP Training

3 Examples of Provincial FETP 3 Examples of Provincial FETP

Zhejing ： 14 cohorts since 2004 ， 230 trainee 。Year budget :500000RMB5 City FETP 。

Guangdong ： 8 cohorts since 2004 ， 75trainee, total 4530000 RMB input

Guizhou ： 9 cohorts ， 133 trainee 。 Budget from 250000 (2004) increased to 500000 RMB 2010 。

Bi-weekly dispatch since 2010 to MOH, all trainee and alumni

Bi-weekly dispatch since 2010 to MOH, all trainee and alumni

Annual mentor workshop Annual mentor workshop

Since 200540-60 trainee for each 

        Mentors and managers from training base        Provincial mentors        CFETP  graduatesTopics 

        Knowledge  needed         Management 

Since 200540-60 trainee for each 

        Mentors and managers from training base        Provincial mentors        CFETP  graduatesTopics 

        Knowledge  needed         Management 

Graduates in 27 of 31 provinces in 10 years

Graduates in 27 of 31 provinces in 10 years

Director or vice Director

Other key positions

206* graduates of CFETP in 12 years206* graduates of CFETP in 12 years206* graduates of CFETP in 12 years206* graduates of CFETP in 12 years

National Provincial Local Total

Graduates 61 71* 74 206Director or

Vice director 12 25 26 63

Key position 41 43 45 129

MOH 1 - - 1CFETP 5 - - 5

*: 1 deceased

Annual China FETP ConferenceAnnual China FETP Conference

Platform     presentation of  of important events of past year by trainee of  China FETP system     

      qualification of output:   question and comment      introduce new trainee to all Attendees

Central and local FETP trainee, trainer;CFETP alumni;CFETPV;Leaders and mentors; Hong Gong FETP and other guests 

FETP night: act by cohort and province

Platform     presentation of  of important events of past year by trainee of  China FETP system     

      qualification of output:   question and comment      introduce new trainee to all Attendees

Central and local FETP trainee, trainer;CFETP alumni;CFETPV;Leaders and mentors; Hong Gong FETP and other guests 

FETP night: act by cohort and province

Celebrating 10th anniversary of CFETP in 2011

Celebrating 10th anniversary of CFETP in 2011

6th annual conference of CFETP

Department/ProgramNational 1.3 billion

Provincial 37 million

Prefecture 4 million

Total

Emergency Response/Surveillance

35 124 666 825

Immunization 15 93 666 774CFETP 10 - - 10Infectious Disease 10 62 333 405Viral Disease 10 31 333 374Parasite Disease 7 31 - 38HIV/AIDS 10 31 333 374Tuberculosis 10 31 333 374Chronic Disease 20 93 333 446Foodborne Disease 15 62 333 410Environmental Disease 10 31 333 374Ocupational Disease 10 31 - 41Others 19 31 333 383

Total 181 651 3996 4828

Minimal Estimated Needs of Qualified Epidemiologists in China

Minimal Estimated Needs of Qualified Epidemiologists in China

Global TEPHINET Spain ’03

TEPHINET India ’06

International Scientific Work- 136 abstracts from 97 officers- 109 publications- Foege and Best poster awards

International Scientific Work- 136 abstracts from 97 officers- 109 publications- Foege and Best poster awards

US EIS International Night ’03

US EIS Intl Night ’07US EIS International Night

’04

TEPHINET Philippines ’04

Global TEPHINET Brazil ’07

Support the development of Mongolian FETP in 2010

Support the development of Mongolian FETP in 2010

• Assign instructor to

Mongolia for 2 months

• Instruct MFETP

• Anthrax outbreak

• Nosocomial infection,

etc.

• Assign instructor to

Mongolia for 2 months

• Instruct MFETP

• Anthrax outbreak

• Nosocomial infection,

etc.

2013 年 亚洲 FETP 培训班2013 年 亚洲 FETP 培训班

Story 1:    Response to SARS Outbreak 

SARS response and survey

CFETP was fully involved in the SARS Investigation 2003

Ren Min Hospital(RMH) in 2003Ren Min Hospital(RMH) in 2003

Affiliated to a very famous university in BeijingOne Door just face to MOHLarge amount of patients compared to smaller campusBe tasked to admit SARS patients

SARS in-patients were resided in such temporary wards

including laundry and boiler rooms

More and more out-patients and doctors/nurses were infected

Hospital was strongly ordered to control hospital infection as

soon as possible, but the situation got worse and worse

Affiliated to a very famous university in BeijingOne Door just face to MOHLarge amount of patients compared to smaller campusBe tasked to admit SARS patients

SARS in-patients were resided in such temporary wards

including laundry and boiler rooms

More and more out-patients and doctors/nurses were infected

Hospital was strongly ordered to control hospital infection as

soon as possible, but the situation got worse and worse

April 22,2003,CFETP’ survey in RMH

• CFETP actively asked to do a field survey assignment in RMH and soon authorized by the Beijing Government

• A Joined team was led by the director of CFETP• Survey in RMH started at 8:00 am in the morning• CFETP director and one trainee went around out-patient and in-patient area under the help of a guide• Survey finished in 3 hours• Conclusion were made in the noon time and immediately

communicated with hospital

Results • All the suggestions were adopted by Beijing

Government: In two days RMH was quarantined In seven days a new famous

hospital ,“Xiaotangshan Hospital ”, was established

Epidemic of terror to SARS in Beijing went down Epidemic of SARS in Beijing went down• National strategy against SARS was determined

43

Story2: Response to novel HIN1 pandemic,2009

6.5 ，成都三院收治一例疑似H1N1 感染病例：

- 女， 40 岁，美籍华人，收银员

首发病例参加九寨沟旅行团：- 23 人从成都加入（不包括首发病例）- 7 人从九寨沟加入- 旅行中首例出现发热、咳嗽、流涕，渐重

旅行团中开始有人陆续发病

旅行团成员在两个航班上所乘坐的区域A B C ED F

56789

101112131415161718192021222324

6月3日CZ6659

A B C ED F56789

101112131415161718192021222324

6月5日CZ6660

旅行团成员

首例病例

二代病例集中在旅行团成员所乘坐的区域A B C ED F

56789

101112131415161718192021222324

6月3日CZ6659

A B C ED F56789

101112131415161718192021222324

6月5日CZ6660

旅行团成员

首例病例

二代病例

最后一例病例

大巴车上病例分布情况司机

6月3日13-16时大巴

司机

6月3日19-22时大巴

未发病旅行团成员

首例病例

二代病例

Challenges during the investigation

• More than 300 close contacts concerned durning 3 days tours.

• Large amount of information need to be collected

• The primary case uncooperative

• Multi-departmental collaboration

• Interviewed 1-2 hours for each contact

Conclusion • This outbreak was apparently caused

by droplet transmission during coughing or talking.

• Airborne transmission was not a factor is supported.

• This investigation highlighted the need to prevent transmission by droplets and fomites during a pandemic.

Published in Emerging Infectious Disease, Vol.15 No.10 Oct 2009

Finance and Collaboration •Financial support from MOS and MOM •Collaboration with

epidemiologists at local

clinical doctors

microbiologists

environmental experts

geologists

other specialists

THANKS